改良神经束膜、外膜联合缝合法在促进足趾皮瓣移植修复拇手指指腹感觉功能中的应用

Application of Modified Nerve Bundle Membrane Combined with Suturing Method in Repairing Thumb Pulp Sensory Function by Promoting Toe Skin Flap Grafting

目的:探讨改良神经束膜、外膜联合缝合法在促进足趾皮瓣移植修复拇手指指腹感觉功能中的应用。方法:选取本院2014年1月-2016年1月收治入院的采用改良神经束膜、外膜联合缝合法治疗的足趾皮瓣移植修复拇手指患者52例(60指),切取皮瓣的面积:1.3 cm×1.5 cm^2.8 cm×3.2 cm,供区直接缝合或植皮修复。结果:术后52例(60指)再造拇手指及皮瓣或供区植皮全部存活。其中4例(4指)术后发生血管危象,经手术及时探查后全部成活,1例(2指)皮瓣远端发生小面积坏死。远端皮肤少量坏死1例(1指)。足部供区:第1跖背动脉岛状皮瓣逆行转移后远端皮瓣小面积坏死1例(1指)。足趾创面植皮后成活欠佳5例(7指),经换药治愈。术后3例(5指)失访,49例(55指)获得随访,术后随访9~26个月,平均(16±3)个月。运动功能:指间关节活动度15°~75°(指间关节功能位固定2例除外),平均(53°±14°),对掌、对指功能无异常,拾、捏细小物品能力差。患者治疗后传导速度和波幅等神经电生理指标均明显高于治疗前,差异均有统计学意义(P<0.05)。49例(55指)患者,优38例(40指),良8例(11指),优良率为92.7%(51/55)。足部症状:局部瘢痕疼痛3例;植皮处偶有破溃2例;奔跑时局部有不适与痛感2例。结论:改良神经束膜、外膜联合缝合法在促进足趾皮瓣移植修复拇手指指腹感觉功能中可获得较好的临床效果,对外形要求较高的患者比较适用。

Objective：To explore the application of modified nerve bundle membrane and outer membrane combined suturing method in repairing palmar and finger sensory function of the thumb and finger by transplanting the toe skin flap.Method：52 cases（60 fingers） were repaired by skin flap of the toes treated with modified nerve bundle membrane and external suture combined with suture method in our hospital from January 2014 to January 2016,the area of the flap was：1.3 cm×1.5 cm2.8 cm×3.2 cm,the donor site for direct suture or skin graft repair.Result：52 cases（60 fingers） of the reconstructed thumb and flap or donor site all survived.4 cases（4fingers） developed vascular crisis after operation,all survived after operation and 1 case（ 2 fingers） had small area necrosis.Distal skin necrosis in 1 case（ 1 finger）.Foot donor site：1 case（ 1 finger） of small area necrosis of distal flap after retrograde transfer of the island flap of the plantar dorsal metacarpal artery.5 patients（ 7 fingers） survived after skin grafting.All the patients were followed up for 9 to 26 months,the mean follow-up time was（ 16±3）months.Motor function：interphalangeal joint activity 15°-75°（interphalangeal joint function in 2 cases,except）,the average（ 53°±14°）,on the palm of the finger function was no exception,pick up,pinch small items poor.After the treatment of patients with conduction velocity and amplitude of nerve electrophysiological index were significantly higher than those before treatment,the differences were statistically significant（P〈0.05）.49 patients（55 fingers） were excellent in 38 cases（ 40 fingers）,good in 8 cases（ 11 fingers）,the excellent and good rate was 92.7%（51/55）.Foot symptoms：local scar pain in 3 cases;skin ulceration occasionally in 2 cases;running local discomfort and pain in 2 cases.Conclusion：Modified nerve bundle membrane combined with suturing method can improve the clinical effect of the toe skin flap grafting on the palpation of the thumb and finger,patients with higher requirements for the appearance of more applicable.